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Business combinations - Narrative, PRA Acquisition (Details)
$ / shares in Units, $ in Thousands
 6 Months Ended 12 Months Ended
Jul. 01, 2021
Employee
$ / shares
shares
Dec. 31, 2021
USD ($)
Employee
Dec. 31, 2021
USD ($)
Employee
Dec. 31, 2020
USD ($)
Dec. 31, 2019
USD ($)
Business Acquisition [Line Items]          
Number of employees | Employee 38,000 38,330 38,330    
Transaction and integration related (Note 6)     $ 198,263 $ (759) $ 4,085
Total financing costs     182,423 13,019 13,276
Transaction and one time financing costs     75,391 $ 0 $ 0
PRA Health Sciences, Inc          
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        
Transaction and integration related (Note 6)     198,300    
Acquisition related costs     57,100    
Total financing costs     86,700    
Gross debt issuance costs   $ 76,200 76,200    
Revenue of acquiree since acquisition date   2,053,400      
Pre-tax net income of acquiree since acquisition date   $ 169,900      
Transaction and one time financing costs     $ 86,700