As a fresh-minted medical practitioner in Chiang Rai, Chatree Duangnet had to remove bullets from gunshot wounds, perform caesarean sections, and treat perforated ulcers.

He saw patients die.

It wasn't anybody's fault. "But it wasn't fair," he reflects.

"People in Thailand deserve to have quality and safe care, not the care that I gave when I didn't have much knowledge."

He had a lot of heart and guts. But his head knowledge just wasn't enough.

Success and struggle

Today, Dr Chatree Duangnet is synonymous with quality medical care in Thailand, a pioneer in getting Joint Commission International (JCI) accreditation – the gold standard in healthcare – not just for one but two hospital networks there.

In the past decade, the CEO of Bangkok Hospital Medical Centre has led his team to gradually transform the more than 50 hospitals in Bangkok Dusit Medical Services (BDMS), the largest network of private hospitals in Southeast Asia.

However, his success arose from periods of intense struggle over four decades.

After his early stint in Chiang Rai, Chatree worked in the United States where he struggled to learn English and qualify as a paediatrician. Eventually he established a successful practice, steeping himself in healthcare quality assurance.

His wife and three children had established deep roots in a small town in Pennsylvania, but at age 50, Chatree felt called to return to Thailand.

His wife stayed on in the US with the children for eight months while Chatree left for Bangkok Hospital, which offered him a top job to push for quality care.

His first attempt at transformation failed.

He moved too quickly, spoke like an American CEO, and people thought he was turning a collegial Thai hospital into a farang (foreign) international hospital.

Staff picketed against him. His three-year contract wasn't renewed.

The professional failure hurt deeply, but what was more painful was how he felt he had failed his family.

During that painful period, one of his children suffered a nervous breakdown.

"What have I done to my family?" he asked himself.

It would have been easier for Chatree to return to the US with his family. But he never once questioned his calling.

Head, heart and guts

How do you know when to persist, and when to give up?

"A good leader has to have head, heart and guts," Chatree says.

He had spent decades equipping himself with knowledge and experience; had a deep-rooted conviction about leading quality assurance; and he had guts to persevere when he hit rock bottom.

If he wants to make an impact, a leader must align his abilities, values, and commitment to his purpose, with unrelenting focus.

Chatree felt he had to do it for the hospital – and his family.

The key to aligning head, heart and guts for Chatree was to embrace his path of failure as a God-given learning curriculum for becoming a good hospital administrator.

"What am I going to do with my curriculum? How am I going to respond to this?" These were his daily questions.

His honest estimation of his own errors helped him reach a breakthrough when given a second chance to introduce quality — this time at Bumrungrad Hospital.

This time around, he went slowly.

He focused on building a team that advocated "quality" practices to other hospital divisions.

In 2002, Bumrungrad became the first hospital in Asia to receive JCI accreditation, which marked the beginning of the medical tourism sector.

Eventually, Chatree would be invited back to Bangkok Hospital, the scene of his failure.

He pulled together a top team of just seven individuals who worked together to secure JCI accreditation in more than a dozen hospitals, a remarkable feat in a developing nation.

As Chatree has learnt, the practice of aligning head, heart, and guts can be a deeply painful, soul-wrenching experience – for a leader as well as for the community he seeks to change.

So he teaches his team that the heart matters most when it comes to selecting leaders.

You need your head for making good decisions, and you need guts to persevere.

But above all, you need a good heart to be honest with yourself, your family, boss, and teams.