How are you creatively working around the SharePoint List View Threshold

Hi community

I'm looking for outside-the-box approaches to dealing with the SharePoint List View Threshold (5,000 item limit). I'm familiar with the standard guidance, indexed columns, filtered views, folders, but I'm curious how others have solved this more creatively, especially in M365/SharePoint Online environments where you can't raise the threshold from the admin side.

Additionally, if you've tackled this in a healthcare, government, or other highly regulated environment where you couldn't just move to an external database easily.

Would love to hear what's worked (and what's blown up) in practice. Thanks in advance!