The Dynamic Sustainability Framework (DSF) addresses the paradox of sustainment amid ongoing change by emphasizing continuous learning, adaptation, and improvement of health interventions in response to evolving contexts. Traditional models of sustainability often assume interventions are static and optimal from the start, leading to 'voltage drop' (declining effectiveness over time) and 'program drift' (deviation from protocols reducing benefit). The DSF challenges these assumptions, proposing that interventions should be continuously refined and adapted to fit dynamic healthcare environments. It integrates concepts of continuous quality improvement (CQI) and a learning healthcare system, focusing on ongoing adaptation and optimization rather than static outcomes. The framework highlights the importance of ongoing feedback, relevant measures, and the ability to adjust interventions to changing contexts. It also emphasizes the need for organizational learning and stakeholder involvement to ensure interventions remain effective and sustainable. The DSF suggests that sustainability is not a final stage but an ongoing process of improvement, requiring continuous evaluation and adaptation. By embracing change as a central factor, the DSF aims to enhance the impact of health interventions in diverse and evolving settings. The framework supports research, policy, and practice by promoting the development and testing of falsifiable hypotheses and ongoing learning to advance implementation, transportability, and impact of health services research.The Dynamic Sustainability Framework (DSF) addresses the paradox of sustainment amid ongoing change by emphasizing continuous learning, adaptation, and improvement of health interventions in response to evolving contexts. Traditional models of sustainability often assume interventions are static and optimal from the start, leading to 'voltage drop' (declining effectiveness over time) and 'program drift' (deviation from protocols reducing benefit). The DSF challenges these assumptions, proposing that interventions should be continuously refined and adapted to fit dynamic healthcare environments. It integrates concepts of continuous quality improvement (CQI) and a learning healthcare system, focusing on ongoing adaptation and optimization rather than static outcomes. The framework highlights the importance of ongoing feedback, relevant measures, and the ability to adjust interventions to changing contexts. It also emphasizes the need for organizational learning and stakeholder involvement to ensure interventions remain effective and sustainable. The DSF suggests that sustainability is not a final stage but an ongoing process of improvement, requiring continuous evaluation and adaptation. By embracing change as a central factor, the DSF aims to enhance the impact of health interventions in diverse and evolving settings. The framework supports research, policy, and practice by promoting the development and testing of falsifiable hypotheses and ongoing learning to advance implementation, transportability, and impact of health services research.