This article discusses methods of mapping and standardizing processes in physician offices and ambulatory settings. It reviews the phenomenon of process shift: how a process, once established, changes over time and loses its effectiveness. The article presents the importance of this shift and how it leads to poor performance, along with methods to prevent it from occurring. The author details the development of process measures and internal benchmarking as a way of ensuring the ongoing integrity of office operations and maintenance of a high-performing office. The author also reviews the need to link job descriptions to process flowcharts.