Leadership Journal

In his masterful book Better, surgeon Atul Gawande writes that in the 1950s, newborn babies in the United States faced great danger: "One in thirty still died at birth—odds that were scarcely better than they were a century before—and it wasn't clear how that could be changed."

An anesthesiologist named Virginia Apgar was appalled: "Babies who were malformed or too small or just blue and not breathing well were listed as stillborn, placed out of sight, and left to die." Apgar believed these infants could be saved, "but she had no authority to challenge the conventions. She was not an obstetrician, and she was a female in a male world. So she took a less direct but ultimately more powerful approach: she devised a score."

Apgar gave nurses a way to rate the health of babies at delivery: "Ten points meant a child born in perfect condition. Four points or less meant a blue, limp baby."

This simple score, devised by an unlikely person—she had never delivered a baby, as a doctor or even as a mother—"turned an intangible and impressionistic clinical concept—the condition of new babies—into numbers that people could collect and compare."

And doctors, being both compassionate and competitive, wanted to boost Apgar scores for their newborns. So they began giving babies oxygen or warming them. They switched from giving mothers general anesthesia to spinals or epidurals. They began using prenatal ultrasounds and fetal heart monitors. And what a change: instead of one in every thirty babies dying at birth, today it's one in every five hundred. Virginia Apgar's score is saving the lives of over 100,000 American babies every year.

We need an Apgar score for the church.

As pastors, we care deeply about the health and vitality of our congregations. But how can we grasp congregational health? To use Gawande's words, it's "an intangible and impressionistic" concept. We need a measure that's simple, clear, and life-giving.

Through most of the twentieth century, the prevailing statistic for churches was the number of members. But as younger generations no longer formed their identity in relation to institutions—political party, labor union, fraternal organization, church—membership gradually told less about a congregation's real state. A long-established downtown congregation, for example, might have hundreds on the membership rolls but only a handful in worship.

So beginning in the early 1960s, some denominations began to report on worship attendance, and by about 1975, attendance had become the most widely accepted way to measure a congregation's vitality. Go to any pastors' convention and you'll soon be asked, "How big is your church?" or more crudely, "How many are you running?"

Attendance has hung on now, for almost 50 years, with only minor tweaks. In the 1980s, as well-known congregations added Saturday night services, people began counting "weekend worship attendance." In the 1990s, as churches added video venues and multiple sites, the count expanded like a baby boomer's waistline—"weekend attendance in multiple sites and venues." In the 2000s, with the addition of web campuses, it's not considered cheating to add to your count website viewers of online services. But we're still hoping attendance will tell us something essential about the health of our congregation.

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