Knowledge, Perceptions, and Job Satisfaction of National Emergency Medical Service Employees Regarding Performance Appraisals in Greece: A Comparison of Two Appraisal Systems

Objective: This study examined the knowledge, perceptions, and job satisfaction of employees of the National Emergency Medical Service (NEMS/EKAB) in Greece regarding two successive performance appraisal systems (Law 4369/2016 and Law 4940/2022). Methods: A cross-sectional study was conducted across 11 regional branches of the National Emergency Medical Service using stratified proportional sampling. A total of 1,200 employees (paramedics and administrative staff) with at least one year of work experience participated. Data were collected through anonymous, self-administered questionnaires. Knowledge (range: 0-10), perceptions (range: 7-35), and satisfaction (range: 8-40) scores were calculated. Differences between the two appraisal systems were examined using paired statistical tests, while factors associated with knowledge, perceptions, and satisfaction were further explored using multivariable regression models. Results: The mean knowledge score was significantly higher under the appraisal system of Law 4369/2016 (mean = 7.51, SD = 1.58) compared with Law 4940/2022 (mean = 5.80, SD = 1.90; p < 0.001). In contrast, perceptions were more positive under the newer system (mean = 21.43, SD = 7.38) than under the previous one (mean = 20.62, SD = 7.25; p < 0.001). Similarly, job satisfaction was higher under Law 4940/2022 (mean = 25.05, SD = 8.15) compared with Law 4369/2016 (mean = 23.76, SD = 8.07; p < 0.001). Younger employees and those with fewer years of service reported higher perception and satisfaction scores, whereas greater age and longer work experience were associated with higher knowledge levels but less positive attitudes. Involvement as an evaluator was associated with higher knowledge scores and more positive perceptions, particularly under the Law 4940/2022 system. Conclusions: Although the earlier appraisal system was better understood by employees, the newer system was perceived as more supportive and was associated with higher job satisfaction. Strengthening training, transparency, and employee participation appears to be critical for improving the acceptance and effectiveness of performance appraisal systems within the National Emergency Medical Service.