Transitioning to a new facility can be challenging for employees and detrimental to operations. A key aspect of the transition is employee understanding of, and involvement in, the design of the new facility. The literature lacks a comprehensive study of the impact of change engagement throughout the design, construction, and activation of a project as well as how that can affect perceptions, expectations, and, eventually, satisfaction of employees. The purpose of this research was to examine employee perceptions and satisfaction throughout a hospital design, construction, and activation process. Three pulse-point surveys were administered throughout the transition of a children’s hospital emergency department and neonatal intensive care unit to a new facility. We also administered a postoccupancy survey 3 months after the move into the new facility. We received 544 responses and analyzed them to assess the relationship between involvement in design or change engagement initiatives and overall perceptions. The results revealed a strong relationship between employee engagement and their level of preparedness to move, readiness to adapt, and satisfaction. Early involvement in the design of a facility or new processes can significantly affect staff preparedness and readiness to adapt as well as employees’ overall satisfaction with the building after occupancy. In addition, our findings suggest that keeping a finger on the pulse of employee perceptions and expectations throughout the design, construction, and activation phase is critical to employee preparedness and satisfaction in transitioning to a new facility.