預算目標可能因應環境的變化而適時修正，因此管理當局必須當機立斷制定出目標調整決策。本研究以違反預期理論作為理論基礎，進一步探討在不同策略性溝通的權變效果下，預算支出目標調整之困難度與預算績效間是否存在其他中介變數（預算執行彈性、預算執行衝突）之影響。透過問卷調查方式取得國內區域級醫院的227位醫療部科主管之研究資料，實證結果發現：（1）在策略性溝通程度低的醫療組織中，預算支出目標調整之困難度經由負向影響預算執行彈性，進而才間接引發負向的預算績效。（2）在策略性溝通程度高的醫療組織中，預算支出目標調整之困難度經由負向降低預算執行衝突，進而才間接導致正向的預算績效。（3）預算支出目標之調整決策確實讓預算主管減少許多可動用之預算資源，同時增加預算流用之困難度。 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.