The purpose of the trial was not to measure worker health.
Its primary goal was to gauge the effects that a reduced work day had on the productivity of 68 full-time nurses and on the care they provided to their 72 patients. The nurses received their full pay during the trial - it was not cut because of the reduced hours.
The $1.3 million trial, conducted from February 2015 to December 2016, was also designed to illuminate the effects a shorter workday (and 30-hour week) had on employee quality of life and local employment.
"There was also a feminist agenda," Bernmar said of the study, which included only women. "A six-hour workday will increase the ability of women to achieve economic independence. A shorter workday means that female part-timers will be translated into full-time jobs."
The nurses working six hours took 4.7 per cent fewer sick days and fewer work absences than when they worked eight-hour days. A comparative group of nurses working eight hour days actually increased the number of sick days during the trial by more than 60 percent.
Maria Ryden, a Conservative Party member of the city council and a former registered nurse, said the study was flawed.
"Who wouldn't work better if you only had to work six hours?" Ryden said. "But somebody still has to pay for it. It's crazy and irresponsible."
Ryden said the study was politically motivated by the Left Party as a way to reduce the length of the workweek.
"The results should have been so much better as a result of so much money and all this effort," Ryden said. "I would have expected much better results than a 4.7 per cent improvement in sick leave."
One important takeaway that both sides may agree on suggests that there are health savings to be mined if employees' work hours are reduced.
Perhaps not surprisingly, the number of nurses who had energy when they left work after six hours increased from 1 in 5 to more than half compared to when they worked eight hours.
Having the energy to spend the rest of your day productively may have also led to a 24 per cent improvement in the level of physical activity.
"Less tiredness and more physical activities is the major improvement," said Bengt Lorentzon, one researcher on the study.
Being tired at the end of the day means "not being able to do anything and just sitting on the couch and looking at the television."
The study reached other conclusions as well: the six-hour nurses overall were more active, less sick, less stressed and had less back, neck and shoulder pain than nurses working eight-hour shifts.
Lorentzon and other experts said the 23-month experiment was not long enough to prove that reduced hours can save on health costs.
Eduardo Sanchez, chief medical officer for prevention at the American Heart Association, said his examination of a summary of the Swedish study points toward a six-hour day being beneficial to one's health, "but I wouldn't go so far to say that's absolutely the case."
Sanchez said if the study had been longer than 23 months, "it might have concluded that, actually, the six-hour workday doesn't cost more because the cost of more employees would be offset by the lower cost of less sick says and a more productive workforce that doesn't utilize medical care as much."
"They might have extended the study a little bit to understand the effect," Sanchez said. "Did they look at all the factors that might have better answered the question of, 'Is this a good thing? Is this a neutral thing? Or is this not so good a thing?' "
A 2014 study of 10,000 employees of the Baptist Health South Florida system concluded that good cardiovascular health translated into annual health-costs savings of $4,000 to $6,000 for healthy hearts compared to employees with higher risk profiles.
In Gothenburg, "we found workers were more efficient in six-hour days than eight-hour days," Lorentzon said. With fewer hours, the nurses better managed their duties, including spending more time with the residents.
"They would go the extra mile for the inhabitants," Lorentzon said. "They had more time to sit down and listen, read a book, look at a newspaper with them, play a game or comfort some of the inhabitants not feeling so good."
In the United States, nearly all health-care facilities use a 12-hour shift schedule for nurses, which often ends up being 13 hours.
"We don't really know what the effect of a six-hour work schedule for US nurses would be because it has not been studied here," said Jeanne Geiger Brown, an expert on nurse work schedules and dean of Stevenson University in Baltimore.
"It's possible that patient care would improve because nurses would be less fatigued and more satisfied with their jobs. On the other hand, it would increase the number of handoffs in patient care, and each patient would have to adjust to four nurses a day rather than two."
Annie Perrin, a partner at Leaders' Quest, a nonprofit leadership development organization, said improving the work lives of nurses could reduce burnout, keep good nurses on staff longer and improve the experience of patients with better care and compassion.
"It may be in the short term more expensive around certain metrics," Perrin said. "Over the long haul, they might get a really good return."
"Retraining new nurses is very expensive," Perrin said. "The other metric in health care is the direct relationship between staff and customer experience. The two things that tend to differentiate health institutions in attracting top talent is geography and the staff experience. If a hospital wants to be more competitive in attracting talent, one of the key ways to do that is to have a really great work environment and employee experience."
Gothenburg spent $1.3 million on the study, which paid for hiring 15 more nurses to make up for hours that the full-timers lost to the shortened workday. The study ended when the funding ran out.
The city's experiment is unlikely to end the heated political discussion over wages, employment and work-life balance in Sweden and elsewhere.
"Of course the study is controversial," Bernmar said. "The opponents want us to work more not less and only focus on short-term economics. This trial has showed the opposite, that working less can be a key factor to a more sustainable working life."
