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.

Problems with the prevailing metric

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.

Why does attendance hang on? First, it's simple. An usher with one bad eye can get the number for you.

Second, attendance, unlike membership, means the same thing everywhere.

Third, it's meaningful: Size determines the size of church staff and correlates with annual giving, which is the most influential factor in a senior pastor's compensation.

Finally, size confers social status, speaking engagements, and book contracts. As C. S. Lewis pointed out, medieval people were fascinated by light, but we moderns (and even avowed postmoderns are building on modern rubble) are fascinated by size.

Size even has scriptural support. Proverbs 14:28 states an immutable law of leading human organizations: "A large population is a king's glory, but without subjects a prince is ruined." So don't expect attendance to easily yield its proud place to budget, baptisms, or blog traffic.

And yet. We can't shake the feeling that measuring a local church by weekly attendance is at best insufficient and at worst misleading. What's wrong with it?

The missionally minded question attendance's very premise: It may measure a church's ability to be attractional, but what does it say about its ability to be missional? Many leaders are calling for a radical shift, from counting how many people are in the church service, to counting how many church people are in service. Why not measure the drop in the local community's teen pregnancy rate or the number of wells dug in sub-Saharan Africa?

Isn't there something malodorous in the fact that church attendance clings closely to what Americans value—bigness and money? The radical message of Jesus flips those on their back and honors the tiny (think pearl), the hidden (think yeast), and the willing-to-decay (think grain of wheat).

Even the pastor with a dog-eared copy of The Effective Executive has to admit that attendance focuses on one activity in the Christian life (gathering together, Heb. 10:25) rather than the more-important outcome—conversion or obedience or perseverance or maturity (Matt. 28:20). Peter Drucker pointed out decades ago that "All nonprofits have one essential product: a changed human being." As much as we wish church attendance led inexorably to life change, we know that's not the case.

We need to move beyond measuring churches primarily by attendance. We need a new measure. We need an Apgar score. I'm just crazy enough to propose not just one, but two possibilties.

Virginia Apgar's score measured a baby in five ways. On each, the baby can score either 0 (low), 1 (middle), or 2 (high). To make the five measures easy to remember, some ingenious nurse arranged them so they spell Virginia Apgar's last name:

Appearance (skin color):

0 = blue all over
1 = pink body, but blue extremities
2 = pink all over

Pulse (heart rate):

0 = less than 60
1 = 60 to 100
2 = over 100

Grimace (reflex irritability):

0 = no response to stimulation
1 = grimace or feeble cry when stimulated
2 = sneeze, cough, or pulling away when stimulated

Activity (muscle tone):

0 = none
1 = some flexion (pulling in of limbs)
2 = active movement


0 = absent
1 = weak or irregular
2 = strong

Total the five scores (none of which is size related), and you have a clear indicator of a baby's health: 10 means a baby born in perfect health, though any score from 7 to 10 is generally normal; 4 means a blue baby needing immediate intervention.

What if we created a measure of church vitality that is just as simple? One that is profoundly biblical? One that motivates positive change, independent of size of church or surrounding conditions?

Yes, Virginia, there is a church Apgar score. Actually, here are two.

We might base a "Church Apgar Score" on Acts 2, Luke's proud snapshot of the healthy, bouncing baby church in Jerusalem (see chart above). I reflected on our congregation and gave it an Acts 2 Apgar Score of 6, maybe 7. Other leaders might rate it higher, which is fine with me. The point is not so much the score as the direction, and I think our leaders would agree that in the past few years, we've moved up, praise God.

To view the Acts 2 Church Apgar chart click here. To take this assessment online click here.

If you don't like those categories, another possibility is found in Revelation 2. This Church Apgar offers a different perspective. Here I credit my pastor friend Lee Eclov, who generally lets me pick up the tab for lunch.

He earned several lunches with his brilliant insight, which we publishedonline ("Jesus' Surprising Definition,"

He writes: "In the second and third chapters of John's Revelation, in a uniquely direct way, we have the Lord's assessment of health indicators for local congregations."

For a church Apgar, Revelation offers advantages: a larger sample size—seven congregations rather than one—and descriptions of not just church strengths, but also church weaknesses (which sound curiously like our own).

To view the Revelation 2 Church Apgar chart click here. To take this assessment online click here.

On this scale, I gave our church an Apgar score of 8 (but admittedly, we're not facing the kind of persecution, including martyrdom, that the early churches in Asia Minor did).

Whatever weaknesses these church Apgars may have, they have one powerful strength. They can be done quickly and readily. Like those done in delivery rooms.

Other recent church assessments, such as Natural Church Development, Church Health Assessment Tool, Transforming Church Index, and REVEAL's Spiritual Life Survey, are very helpful—if your church has the time, money, and motivation to hire a consultant and/or get people to take surveys.

Many pastors, though, need a measure that is free and simple, more complete than weekly attendance but just as easy to determine. When I assessed our congregation using these Apgars, within a minute or two I knew where to thank God and where to pray for his help and go to work.

What to do with your church's Apgar

Start by prayerfully assessing your church. Don't let your score lead you into discouragement, that occupational hazard of ministry.As my friend Dave says, "A marker of spiritual maturity is being able to use metrics without feeling undue anxiety about them." Instead, gather a small group of leaders—a church board or staff team—to discuss questions like these:

1. What Apgar score did you give our church, and why?

2. For which of these five areas should we stop right now and thank God?

3. Which of these five areas do we sense God leading us to develop first? How does our answer align with our overall sense of calling?

4. What could we do, starting now, that could boost that area by one point in the next year or two?

Each church's response will vary, though I don't see how concerted prayer could not be included.

Focusing on church attendance (alone) turns us into marketers; focusing on an Apgar score turns us into intercessors. And suddenly the "size equals value" noise begins to fade away, because raising your Apgar score one point is no easier for a megachurch than for a house church. It might be harder.

I have a dream. My dream is to go to a pastors' conference and not hear anyone say, "How many are you running?" or "How big's your church?" Instead, I overhear someone say, "How's your Apgar?" and the other pastor replies, "Oh, a 6. I'd like it to be a 7, but we've moved up from a 5 in the past two years, so I'm feeling good about that."

Call me an idealist, but the way we measure church has changed before, and it can change again.

Kevin A. Miller is assistant pastor at Church of the Resurrection in Wheaton, Illinois, and publisher of Leadership.