Much contemporary writing on organizational culture overstresses consensus. Using a case study of a UK National Health Service district, it is suggested that there can be distinct frames of meaning within one organization. Managers' ideas about creating a unified culture were reflective of an attempt to move from medical dominance to a managerialist orientation, but this change was the subject of considerable dispute. There was debate about whether management was appropriate to an organization that had traditionally relied on administration and the consequent medical autonomy that this implied. Conflicts over the proper role of doctors, managers, and the health service itself meant that this culture was best conceptualized as divided, not shared. Ideas about unity, as theory or management prescription, neglect the many ways in which formulations of us and them shape organizations.