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Business combinations - Narrative (Details) |  |  |  |  |  | 14 Months Ended |  |  |  |  |  |  |
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Jul. 01, 2021 USD ($) Employee Country $ / shares shares | Jul. 17, 2020 USD ($) | Jan. 22, 2020 USD ($) | Sep. 24, 2019 USD ($) | Jan. 25, 2019 USD ($) | Jul. 17, 2020 USD ($) | Jun. 30, 2021 USD ($) | Jan. 31, 2021 USD ($) | Dec. 31, 2020 USD ($) | Jun. 12, 2020 USD ($) | Mar. 09, 2020 | Dec. 31, 2019 USD ($) | May 23, 2019 USD ($)
Business Acquisition [Line Items] |  |  |  |  |  |  |  |  |  |  |  |  |
Goodwill |  |  |  |  |  |  | $ 933,387,000 |  | $ 936,257,000 |  |  | $ 883,170,000 |
Subsequent event |  |  |  |  |  |  |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |  |  |  |  |  |  |
Entity number of employees | Employee | 38,000 |  |  |  |  |  |  |  |  |  |  |  |
Number of countries in which entity operates | Country | 47 |  |  |  |  |  |  |  |  |  |  |  |
PRA Health Sciences Inc | Subsequent event |  |  |  |  |  |  |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |  |  |  |  |  |  |
Business acquisition, share price (in USD per share) | $ / shares | $ 80 |  |  |  |  |  |  |  |  |  |  |  |
Business acquisition, number of shares issued (in shares) | shares | 0.4125 |  |  |  |  |  |  |  |  |  |  |  |
PRA Health Sciences Inc | Subsequent event | Forecast |  |  |  |  |  |  |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |  |  |  |  |  |  |
Total consideration | $ 12,500,000,000 |  |  |  |  |  |  |  |  |  |  |  |
Additional intangible assets recorded from acquisition | $ 5,500,000,000 |  |  |  |  |  |  |  |  |  |  |  |
Medpass |  |  |  |  |  |  |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |  |  |  |  |  |  |
Total consideration |  |  | $ 47,556,000 |  |  |  |  |  |  |  |  |  |
Percentage of share capital acquired |  |  | 100.00% |  |  |  |  |  |  |  |  |  |
Goodwill |  |  | $ 27,191,000 |  |  |  |  |  |  |  |  |  |
Contingent consideration |  |  | $ 0 |  |  |  |  | $ 0 |  |  |  |  |
Symphony |  |  |  |  |  |  |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |  |  |  |  |  |  |
Total consideration |  |  |  | $ 37,800,000 |  |  |  |  |  |  |  |  |
Percentage of share capital acquired |  |  |  | 100.00% |  |  |  |  |  |  |  |  |
Goodwill |  |  |  | $ 22,900,000 |  |  |  |  |  |  |  |  |
Contingent consideration |  |  |  | $ 2,500,000 |  |  |  |  |  | $ 500,000 |  |  |
MeDiNova |  |  |  |  |  |  |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |  |  |  |  |  |  |
Total consideration |  |  |  |  |  | $ 86,200,000 |  |  |  |  |  |  |
Percentage of share capital acquired |  |  |  |  |  |  |  |  |  |  |  |  | 60.00%
Goodwill |  |  |  |  |  |  |  |  |  |  |  |  | $ 81,800,000
Percentage of interest acquired |  |  |  |  |  |  |  |  |  |  | 100.00% |  |
Redeemable noncontrolling interest |  |  |  |  |  |  |  |  |  |  |  |  | $ 32,600,000
Settlement of liability |  | $ 43,900,000 |  |  |  |  |  |  |  |  |  |  |
MMD |  |  |  |  |  |  |  |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |  |  |  |  |  |  |  |
Total consideration |  |  |  |  | $ 42,200,000 |  |  |  |  |  |  |  |
Percentage of share capital acquired |  |  |  |  | 100.00% |  |  |  |  |  |  |  |
Goodwill |  |  |  |  | $ 22,400,000 |  |  |  |  |  |  |  |

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