In many industries, such as manufacturing and logistics, semi-formal process models have become a common means to reason and communicate about business processes. However, in a dynamic and flexible environment the suitability of semiformal process models as an instrument of process documentation may be challenged. Hospital processes are typical examples of business processes that are characterized by both the existence of well-defined procedures and the need for operational flexibility. This research investigates the current practice of process documentation in healthcare by means of a case study in a German hospital. We aim at getting an understanding of how flexible processes may be documented to give medical staff effective guidance and how this documentation has to be managed in order to provide value in everyday routine. On the basis of our findings we give suggestions on how to effectively implement process documentations in similar settings.