PACE-CH: Paramedic Attrition, Career, and Employment in German-Speaking Switzerland: Perceived Leadership Quality, Job Satisfaction, and Turnover Intention

Background: Leadership quality is consistently associated with job satisfaction and turnover intention (TI) in prehospital emergency medical services (EMS). No validated measurement instrument existed for German-speaking Swiss EMS. PACE-CH is the first systematic cross-sectional study to examine these associations in this context. Methods: Two parallel surveys were administered (January–February 2024) to 338 frontline paramedics and 53 managers across German-speaking Swiss EMS organisations. A six-item Perceived Leadership Quality Score (PLQS) was developed, anchored in the Empowering Leadership Questionnaire and the Job Demands-Resources framework. Turnover intention was operationalised as a five-level ordinal variable. Ordinal logistic regression, Spearman correlations, and exploratory bootstrapped mediation analysis (5,000 simulations) were used. All p-values were Benjamini-Hochberg adjusted. Results: Mean PLQS was 3.12 (SD 0.82; α = 0.881; CFI = 0.960, SRMR = 0.039). PLQS showed a moderate-to-strong negative association with TI (r = −0.448) and strong positive associations with job satisfaction (r = 0.640) and employer recommendation (r = 0.662). Each one-unit increase in PLQS was associated with lower odds of higher TI (OR = 0.21, 95% CI [0.13, 0.33]; Nagelkerke R² = 0.235). PLQS alone accounted for 45.1% of variance in job satisfaction. Exploratory mediation analysis indicated that job satisfaction accounted for 51.7% of the total PLQS–TI association (ACME = −0.189, 95% CI [−0.306, −0.081], p = 0.002). No significant differences were found by organisation type, gender, or generation. Discussion: Perceived leadership quality showed stronger cross-sectional associations with all three retention-relevant outcomes than the measured demographic and organisational covariates. Mediation findings were exploratory and require longitudinal replication. Conclusions: Perceived leadership quality is a plausible and measurable dimension of the working environment in German-speaking Swiss EMS. Swiss EMS already generates considerable workforce data; what is currently missing is more systematic analysis of these data and feedback to frontline staff and supervisors