Nuclear medicine department organization and management is an important consideration to ensure effective, efficient workflow processes and to promote a cohesive, collaborative multi-disciplinary team environment. This chapter describes the significance of optimal departmental structure in achieving high-quality patient care. The first section of this chapter will comprehensively outline the various types of organizational structures, explain why it is crucial to assess the specific individual work environments, and provide guidance on how to implement the most appropriate department model. Additionally, it will discuss the benefits of adapting organizational strategies to meet evolving healthcare demands. The key components of the department structure will thoroughly outline the specific roles and responsibilities of all staff, including staffing calculations and estimation methods, optimizing workflow processes to improve throughput efficiency, and highlight the importance of interdisciplinary collaboration with various stakeholders and other healthcare departments. Furthermore, the section will address methods for enhancing workflow based on lean management and risk management. To optimize department efficiency, detailed consideration should be given to workflows, the staff skill mix, department layout, and other critical factors including patient scheduling, advanced information technology (IT) systems such as RIS, PACS, hot laboratory information systems, and diverse types of services offered. Attention to these areas will ensure the department operates at peak performance levels. The value of effective communication and the importance of promoting collaborative relationships in the healthcare setting, especially in the context of a hybrid imaging department, will significantly improve workflow and resource allocation, promote teamwork, and support patient-centred care of the highest quality.