The Question Factory
Harnessing curiosity and creativity to solve complex problems
Have you ever listened to a presentation and thought that either something is wrong with the argument or that you need help understanding the point? Then someone in the audience asks a question, and you say, "Damn, that is a great question!" The ensuing give-and-take between the presenter and interlocutor clarifies the point, the presentation suddenly makes sense, and its relevance to a problem you have been struggling with becomes apparent.
Scenarios like the above play out whenever people gather to solve problems. Sometimes the questions have sticking powers; others get lost in cryptic meeting minutes. Mostly, they are lost in a rush to the next urgent problem-solving session. But what if the questions were treated as the valuable assets that they are?
There are many different kinds of questions. Some questions ask for a description or clarity about a definition. Others questions ask about causes, options for action, implications, and the relative merit of a proposed solution. Each type of question is valuable in different ways, depending on the situation, the people involved, and the nature of the problem being considered. And, of course, there are various ways of answering questions, including empirical data collection, model predictions, prior experience with similar situations, and straight-out guesswork.
The most challenging questions are those that don't have definitive answers. They bring tacit knowledge, opinions, and novel interpretations of data to a fine point. They require weighing evidence from multiple perspectives, consideration of advantages and limitations, and value judgments regarding cost, benefit, and possibility of unintended consequences.
These questions require all the curiosity and creativity we can muster and the patience to consider all dimensions of an issue rather than reaching for a top-of-mind guess at a solution.
Curiosity and creativity come in different flavors. Some people follow their curiosity by delving into the details of a specific problem, while others are content to look for connections with previously encountered situations. Some people use words to express their creativity, while others use pictures, mathematics, or music. We each have our unique profile of curiosity and creativity, and the combination of profiles across teams, communities, and nations contributes to our collective intelligence and capability to solve complex problems.
Often our search for solutions is focused on a particular context. We use our expertise to define a specific context that seems helpful in understanding a problem and generating solutions. The context we choose to work in is a projection of underlying complexity, elements of which might be pushed to the background to make the challenge tractable.
The borders between curiosity, creativity, and the known gaps in knowledge are porous. We search for answers to the questions we know about, and this pool of questions is constantly changing as we gain insight and resolve some questions while discovering others.
By focusing on an issue and examining it from the perspective of multiple profiles of creativity and curiosity, the alchemy that results generates a pool of questions that provide a clearer picture of the context of a problem and a rich source of insight that can drive innovation and inspiration in creating, adopting, or adapting ideas for specific applications.
I have been working with scientists at Makerere University to investigate why the consequences of malaria infection, including mortality in children <5 years of age and poor pregnancy outcomes, have increased with the COVID-19 pandemic in Uganda.
Our initial discussions suggested that several interrelated factors might be contributing to the poor outcomes, including increased transmission due to climate change, increased resistance of the Plasmodium parasite to standard drug regimens, suboptimal dosing regimens, poor quality or counterfeit generic products, supply chain deficiencies, and inadequate implementation of policy recommendations for prevention and treatment.
Information on these adverse factors' nature, severity, and health impact comes from multiple sources, including global health monitoring programs (e.g., WHO Malaria Threat Assessment), discrete research studies, publications, and regional or national surveillance programs.
At first, some of the reasons for poor outcomes seemed obvious and related to the availability of malaria treatments and the healthcare-seeking behavior of patients. Once we established a systematic process for investigating each information channel and began critically reading the research literature and government documents, the many questions that arose pointed to the need for an interconnected set of policies and actions that require the joint initiative of multiple responsible authorities, health care providers and the patients themselves.
The questions below illustrate the interconnectedness of the information channels.
How does climate change affect the rates of mosquito transmission of malaria, and how does the changing seasonal prevalence affect the supply chain? How does the wide availability of antimalarial treatments outside of established healthcare facilities, e.g., via over-the-counter stores, enable the corruption of the supply chain with counterfeit medicines? Does the use of counterfeit drugs vary across the country, and is this related to the risk of resistance of the malaria parasite to front-line drugs? What can be done to improve patient compliance, including social messaging, better formulations, e.g., color and size of tablets, and healthcare provider training?
Many of the questions initially appeared to be the responsibility of a particular government agency or healthcare facility. But dealing with these questions requires a nuanced response based on information from across channels. I want to point out that responding to the questions often requires that essential information be obtained outside the usual channels.
This highlights the training needed for stakeholders from one discipline to recognize the relevance and importance of information from other fields. Further, the questions helped identify information that stakeholders wished they had to understand the context of the problem better. For example, some critical pieces of information, notably supply chain logistics and drug quality testing, need to be developed and strengthened.
By establishing a framework for integrating these diverse sources of information and capturing the pool of questions, along with the data, observations, and hypotheses that spawned the questions, we can create a resource to reexamine the interplay between treatment and prevention policies, drug regimen recommendations, and community-based interventions. We can create a public good that can be used by scientists, governmental agencies, funding agencies, policymakers, and community leaders to support multidisciplinary discourse on emerging options for policy recommendations and communication strategies to improve the outcomes of malaria prevention and treatment programs.
Developing strategies for dealing with complex problems like malaria and other neglected tropical diseases is made more challenging by the fact that the knowledge of the circumstances we must address does not exist in an integrated form but consists of dispersed bits of incomplete and frequently contradictory knowledge possessed by separate individuals.
The people responsible for a specific policy or supply chain can not decide on a course of action based solely on their limited but intimate knowledge of the facts of their immediate area of responsibility. Communication must be established across information channels to secure the additional information needed to make decisions based on a holistic consideration of the proposed changes.
The question factory created by the systematic process of interrogating information and encouraging discourse is a much-needed approach to building coherence across areas of insight and contributing to the checks and balances necessary for resilient action plans. The question-generating process's critical value stems from the questions' quality and diversity. They are a vital resource for finding novel and sustainable solutions to otherwise intractable problems.
We tend to think of scientists, academics, and government policy-makers as the go-to source of questions. With problems like malaria, perhaps it's time to seek questions from beyond the usual suspects. I wonder how many of those questions will generate the response, "Damn, that's a great question!"