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Restructuring charges - Narrative (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Dec. 31, 2018
Restructuring Cost and Reserve [Line Items]        
Restructuring charges $ 31,105 $ 18,089 $ 0  
Impairment of long lived assets 15,400 5,400    
Fixed asset impairment 20,037 5,411 0  
Restructuring reserve 28,353 10,748 1,637 $ 6,419
Transaction and one time financing costs 75,391 $ 0 $ 0  
PRA Health Sciences, Inc        
Restructuring Cost and Reserve [Line Items]        
Transaction and one time financing costs 86,700      
2021 Restructuring Plan        
Restructuring Cost and Reserve [Line Items]        
Restructuring charges 31,100      
Impairment of long lived assets 21,900      
Fixed asset impairment 4,400      
Workforce reductions        
Restructuring Cost and Reserve [Line Items]        
Restructuring reserve 5,200      
Workforce reductions | 2021 Restructuring Plan        
Restructuring Cost and Reserve [Line Items]        
Restructuring charges 4,800      
Lease Liability        
Restructuring Cost and Reserve [Line Items]        
Restructuring reserve 23,200      
Lease Liability | Other current liabilities        
Restructuring Cost and Reserve [Line Items]        
Restructuring reserve 10,400      
Lease Liability | Other Noncurrent Liabilities        
Restructuring Cost and Reserve [Line Items]        
Restructuring reserve $ 12,800