Purpose – The purpose of this paper is to explore sensemaking of incidents by health care professionals through an analysis of the role of professional identity in narratives of incidents. Using insights from social identity theory, the authors argue that incidents may create a threat of professional identity, and that professionals make use of identity management strategies in response to this identity threat. Design/methodology/approach – The paper draws on a qualitative analysis of incident narratives in 14 semi-structured interviews with physicians, nurses, and residents at a Dutch specialist hospital. The authors used an existing framework of identity management strategies to categorize the narratives. Findings – The analysis yielded two main results. First, nurses and residents employed multiple types of identity management strategies simultaneously, which points to the possible benefit of combining different strategies. Second, physicians used the strategy of patronization of other professional groups, a specific form of downward comparison. Research limitations/implications – The authors discuss the implications of the findings in terms of the impact of identity management strategies on the perpetuation of hierarchical differences in health care. Practical implications – The authors argue that efforts to manage incident handling may profit from considering social identity processes in sensemaking of incidents. Originality/value – This is the first study that systematically explores how health care professionals use identity management strategies to maintain a positive professional identity in the face of incidents. This study contributes to research on interdisciplinary cooperation in health care.