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Business Combinations - Narrative, PRA Acquisition (Details)
$ / shares in Units, $ in Thousands
 12 Months Ended
Jul. 01, 2021
Employee
$ / shares
shares
Dec. 31, 2023
USD ($)
Employee
Dec. 31, 2022
USD ($)
Dec. 31, 2021
USD ($)
Business Acquisition [Line Items]        
Number of employees | Employee 38,000 41,100    
Integration related costs   $ 44,176 $ 39,695 $ 198,263
Total financing costs   336,699 229,731 182,423
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      
Total financing costs   $ 16,400 $ 17,700 $ 86,700