Basically, I get my settings ready, turn my machine sideways and start quilting.
I always start from the center of the quilt outwards. I usually work towards the quilt that is rolled up in the throat of the machine and work from side to side that ways. Then, I turn the quilt around, and work the other way. It's not a perfect art. Sometimes I end up going in different directions, depending how the groove goes, and how much bunching occurs. I have to tell you though, it is so much easier on your shoulders and your posture, and your hands have a good handle on the fabric and can move your fabric easier.
If you were doing something more intricate like feathering, or directional design, I'm sure you'd have to tweak the fabric positioning according to your design. But, hey, this works for me, and it's quite enjoyable. Here's a very candid video my husband took. He thinks I'm crazy for blogging. I think HE'S crazy, especially since the first 3 seconds of the video was just cleavage shots he took of me. LOL!