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The research focused on how pastors describe systemic health, what pastors believe to be hindrances to systemic health, and how pastors cultivate systemic health within their congregations. The literature reviewed included biblical and theological material relating to a congregation's systemic nature and the definition of congregational gospel health; change theory; systems theory; and the leader's role. The researcher interviewed two senior pastors of two different churches, their spouses, staff, and lay leaders. Both senior leaders articulated four factors that the literature supported: personal and marital growth; thinking systemically about the congregation; a working knowledge of change theory; and having at least one co-laborer in the work of change. 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Kirk of the Hills, a PCA church in St. Louis, Missouri, is currently using the model for pastoral care as proposed for large churches.  Questionnaires were completed by those in leadership and by active church members to determine the degree of effectiveness of pastoral care. 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