Pathology and Laboratory Medicine discipline occupies a special place in the medical school and healthcare ecosystem as it bridges basic medical science and clinical practice. In the era of rapid knowledge and technology evolution, the new ways of communication, new training requirements, and the demand of personalized precision diagnostics, this specialty is facing unprecedented challenges and opportunities. Some of these challenges are institution-specific, while many are shared worldwide at different magnitudes. This review shares our team efforts in effectively dealing with challenges of budget constraints, engaging diverse and distributed faculties to establish and implement a shared vision and strategy to achieve sustained improvement in education programs and research enterprise. We hope that our experiences and insights can inspire other university departments in finding innovative approaches for their unique challenges and opportunities.