Budgeting goal may be revised in response to changes in the environment, so the management needs to make goal adjustment decisions to meet timeliness. Based on the theory of expectancy violation, this study explores the impact of mediating variables (budget executive flexibility and budget executive conflict) between difficult adjustments in budget expenditure goal and budgeting performance under the contingent effect of different strategic communication. Research data were obtained from 227 medical department supervisors in regional hospitals by questionnaires. Empirical results show that: (1) In the medical organizations with low strategic communication, difficult adjustments in budget expenditure goal negatively affects departmental supervisors' budget executive flexibility, which indirectly leads to negative budgeting performance. (2) In the medical organizations with high strategic communication, difficult adjustments in budget expenditure goal negatively reduces departmental supervisors' budget executive conflict, which indirectly leads to positive budgeting performance. (3) The budget goal adjustment decision indeed diminishes budgetary resources for medical department supervisors, and creates additional difficulty for budgetary transfers.