> the flow of electrons always in the same direction as the current flow?
Who cares???
The only place we REALLY care is in thermionic vacuum tubes. There we know current is carried ONLY by electrons, and they flow up to B+. Even so, most napkin sketches use arrows pointing down. It really makes no difference.
OTOH, in gas-tubes, there is a huge flow of positive ions. Electrons are still the main current, but the positive ions break-up the electrons' fields, allowing MUCH more current flow than you can boil off a thermionic cathode.
And in solid-state, positive and negative "charges" have about equal weight. The concept of "holes" seems empty, but holes in electron-rich solids are very effective current carriers. Not just in doped silicon: copper wire has "holes" "moving" backward from the electron flow. The total number of electrons in a hunk of wire is preserved constant, yet "something moves". We could just as well have decided to count copper holes when measuring current.
The generally accepted equations needed a sign-convention. At that time the nature of current flow was not understood at the particle level, and we now see that either positive or negative charges, or both, may be useful in different devices.
> mistakenly thought electrons flowed from positive to negative.
No, they didn't know what electrons were or which way they flow. They did know there were "two types" of electricity: some things cling and some things repel. The sign-convention arbitrarily picked one polarity to call "positive" so the math would work out right. It later turned out to be significantly easier for some devices to isolate and use negative charges than positive charges.
> designer writing about his/her circuit might say, "then current flows through R11 to ground", which intuitively makes me think the voltage must be negative with respect to ground.
Do not read too much into technical writing. Sometimes it is pedantically perfect (W. Marshall Leach tends to get it right); very often the writer has great understanding of napkin sketches and general circuit balance, yet a sloppy way with words.
However assuming the writer is using the mathematical convention for current sign, then "current flows through R11 to ground" implies that the un-grounded end of R11 is positive. Even if R11 is the cathode resistor for a vacuum tube. Many tube-heads insist that current flows plate to cathode, even though "we know" the electrons flow cathode to plate.
As bcarso says: if you are from another planet (some members here may be), then your results may be different. Send your excess P-type anti-vacuum tubes to earth so we can make complementary pairs.