Exodus of clergy: The role of leadership in responding to the call

Leaders play an important role in clergy’s response to their call. Toxic leadership, also known as the dark side of leadership, negatively influences their decision to remain in full-time pastoral ministry. There is a shortage of clergy in the Roman Catholic Church and a distribution or displacement challenge facing the Protestant church. This shortage adversely affects the future of the church as clergy play an integral part in the preparation of congregants for their works of service (Eph 4:11–12). The purpose of this study was to discover what factors were involved in clergy’s response to the call to full-time pastoral ministry. A practical theological grounded theory approach was used to discover the properties of the category ‘leadership’. Semi-structured interviews were conducted and data were coded using Glaser and Strauss’s grounded theory methodology. The category of ‘leadership’ includes properties such as favouritism, leaders abdicating responsibilities, leaders taking no action/being inactive, leaders ‘labeling’ subordinates, leaders’ ‘unethical’ behaviour, nepotism, poor conflict handling, poor handling of multi-racial issues, being placed on a pedestal, affirming subordinates and autocratic leadership style. Osmer’s descriptive-empirical task was used as a practical theological lens through which to view the category ‘leadership’. The results indicated three responses by clergy to the call to full-time pastoral ministry: not being called in the first place, a dual call (being bi-vocational or ‘seasonal’) and being called but leaving anyway because of, among other factors, toxic leadership. A steward leadership approach is recommended in response to the dark side of leadership

Using resource modelling to inform decision making and service planning: the case of colorectal cancer screening in Ireland

Background - Organised colorectal cancer screening is likely to be cost-effective, but cost-effectiveness results alone may not help policy makers to make decisions about programme feasibility or service providers to plan programme delivery. For these purposes, estimates of the impact on the health services of actually introducing screening in the target population would be helpful. However, these types of analyses are rarely reported. As an illustration of such an approach, we estimated annual health service resource requirements and health outcomes over the first decade of a population-based colorectal cancer screening programme in Ireland. Methods - A Markov state-transition model of colorectal neoplasia natural history was used. Three core screening scenarios were considered: (a) flexible sigmoidoscopy (FSIG) once at age 60, (b) biennial guaiac-based faecal occult blood tests (gFOBT) at 55–74 years, and (c) biennial faecal immunochemical tests (FIT) at 55–74 years. Three alternative FIT roll-out scenarios were also investigated relating to age-restricted screening (55–64 years) and staggered age-based roll-out across the 55–74 age group. Parameter estimates were derived from literature review, existing screening programmes, and expert opinion. Results were expressed in relation to the 2008 population (4.4 million people, of whom 700,800 were aged 55–74). Results - FIT-based screening would deliver the greatest health benefits, averting 164 colorectal cancer cases and 272 deaths in year 10 of the programme. Capacity would be required for 11,095-14,820 diagnostic and surveillance colonoscopies annually, compared to 381–1,053 with FSIG-based, and 967–1,300 with gFOBT-based, screening. With FIT, in year 10, these colonoscopies would result in 62 hospital admissions for abdominal bleeding, 27 bowel perforations and one death. Resource requirements for pathology, diagnostic radiology, radiotherapy and colorectal resection were highest for FIT. Estimates depended on screening uptake. Alternative FIT roll-out scenarios had lower resource requirements. Conclusions - While FIT-based screening would quite quickly generate attractive health outcomes, it has heavy resource requirements. These could impact on the feasibility of a programme based on this screening modality. Staggered age-based roll-out would allow time to increase endoscopy capacity to meet programme requirements. Resource modelling of this type complements conventional cost-effectiveness analyses and can help inform policy making and service planning