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Small-bore drains (≤ 16 Fr) are used in many centers to manage all pleural effusions. The goal of this study was to determine the proportion of avoidable chest drains and associated complications when a strategy of routine chest drain insertion is in place.

We retrospectively reviewed consecutive pleural procedures performed in the Radiology Department of the McGill University Health Centre over one year (August 2015–July 2016). Drain insertion was the default drainage strategy. An interdisciplinary workgroup established criteria for drain insertion, namely: pneumothorax, pleural infection (confirmed/highly suspected), massive effusion (more than 2/3 of hemithorax with severe dyspnea /hypoxemia), effusions in ventilated patients and hemothorax. Drains inserted without any of these criteria were deemed potentially avoidable.

A total of 288 procedures performed in 205 patients were reviewed: 249 (86.5%) drain insertions and 39 (13.5%) thoracenteses. Out of 249 chest drains, 113 (45.4%) were placed in the absence of drain insertion criteria and were deemed potentially avoidable. Of those, 33.6% were inserted for malignant effusions (without subsequent pleurodesis) and 34.5% for transudative effusions (median drainage duration of 2 and 4 days, respectively). Major complications were seen in 21.5% of all procedures. Pneumothorax requiring intervention (2.1%), bleeding (0.7%) and organ puncture or drain misplacement (2%) only occurred with drain insertion. Narcotics were prescribed more frequently following drain insertion vs. thoracentesis (27.1% vs. 9.1%, p = 0.03).

Routine use of chest drains for pleural effusions leads to avoidable drain insertions in a large proportion of cases and causes unnecessary harms.

The aim is to identify Henri Fayol's motivations as an accomplished business manager to publish his management theory at the age of 75.

The authors retrace Henri Fayol's private life using primary sources from various French public archives including civil registry records, military and diplomatic archives, schooling records, publications from learned associations and inheritance declarations. They then use a psychological theory, namely equity theory, to interpret this new information about Fayol's private life and construct an explanation of his efforts to theorise his management experience.

Henri Fayol's schooling and his father's military career respectively influenced his perception of mathematics teaching in management training and the functioning of the army. His motivation to found a science of management was not financial but instead most probably a response to the obstacles his father encountered during his career.

It is rarely known what motivates a manager to collaborate with specialists in management science. This research into Henri Fayol's motivations can be replicated for other managers.

The paper dentifies one major practical implication for managers who wish to contribute to management theory as Fayol did. Before they begin such an undertaking, it is important for them to reflect upon their motivations. Their motivations as managers, based on financial and business success are insufficient. Deeper motivations are needed, that are anchored in their own personal history to drive the considerable intellectual investment that is necessary for them to be successful contributors.

The results encourage managers to contribute to building and improving management science. They can theorize their experiences in dealing with the management of contemporary issues such as sustainable development and social responsibility. They must do so as Fayol did: using scientific method and strongly motivated by personal beliefs.

The research question is original: “What motivated Fayol to build his management doctrine?”. Scholars rarely ask why individuals decide to build and organize knowledge. This question is relevant for managers today as they too can bring original contributions to management thought. The paper reports previously unpublished details about Fayol's life to answer the research question, and in doing so completes and corrects the works of Sasaki Tsuneo and Henri Verney.